Markets, Depots and Sales Tables: The Women's Institute's Rural Retailing

In 1917 the Coventry Evening Telegraph noted that the problems of ‘surplus garden produce’ had arisen and that ‘smallholders were being encouraged to group together in order to bring their supplies in quantity to market. Women’s Institutes have been formed, and these arrange for the opening of a market for a certain number of hours one day a week’. WIs, which had begun being formed under the auspices of the Agricultural Organisation Society from 1915 could be seen to be one of the earliest examples of Farmers Markets. These rural women were to improve the food supply in wartime when there was a food crisis; shortages, queues, price rises and in 1918 the introduction of rationing. The WIs encouraged food saving and preservation their markets enabled small holders, cottage gardeners and allotment holders to find a financial non- exploitive outlet for their produce. Markets and retail outlets developed in a number of towns or even cities in rural areas: Worcester, Leamington Spa and Lichfield and in post-war Britain depot trading centres were set up in some county towns Maidstone in Kent in 1919, Winchester in 1920. Between them they provided rural women with a retail space initially for their garden produce and then in time for the preserves, baking and craftwork. Jam, cakes, toys, knitted toys and garments even a wedding trousseau were ordered or sold through these retail outlets. The Markets were not restricted to WI members and often sold work produced by small­holders, the disabled and ex-servicemen. Membership required buying at least one share; as they were a co-operative venture there was a limit on the number of shares it was possible to purchase. Sales tables at some monthly WI meeting provided yet another retail outlet for rural women. This paper will explore the significance of these retail opportunities to rural women: as a chance to earn much needed cash, in placing a value on domestic labour and as an indication that when looking at rural women’s lives, in first half of the twentieth century, divisions between being consumers and producers of food and domestic products may be more fluid than it is something assumed.

Improving Patients’ Experience and Outcome of Total Joint Replacement: the RESTORE Programme

BACKGROUND: Total hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected. OBJECTIVE: To undertake a programme of research studies to work towards improving patient outcomes after THR and TKR. METHODS: We used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement. RESULTS: Systematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test. CONCLUSIONS: The RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.